| NPI | 1841500246 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA KEOUGH Credentialing Rep 405-848-7974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 8315) |
| Enumeration Date | 2010-10-19 |
| Last Update Date | 2010-10-19 |